<div class="infoBlock">
<div class="infoBlockHeading"><span class="t"></span></div>
<div class="infoBlockContent">

<div class="infoBlockItem" style="background-color: #f8f8e0; float: left; display: block; width: 689px; height: 450px;">
<div class="left" style="padding: 10px 10px 10px 10px;">
<img src="{$CONTEXT.STYLEIMG}h_m_6.jpg" />
</div>
<div class="right hbfmd">
<form name="contactusform" id="contactusform" method="post">
<input type="hidden" name="action" value="addcontactus">
<table width="100%" border="0" cellspacing="0" cellpadding="1">
  <tr>
    <td colspan="2">Please fill out the following contact information.<br />We will contact you for arranging your free estimate.</td>
  </tr>
  <tr>
    <td colspan="2" height="5"></td>
  </tr>
  <tr>
    <td colspan="2"><label>Full Name:</label></td>
  </tr>
  <tr>
    <td colspan="2"><input type="text" name="field_name" value="" class="txta"></td>
  </tr>
  <tr>
    <td colspan="2"><label>Email Address:</label></td>
  </tr>
  <tr>
    <td colspan="2"><input type="text" name="field_email" value="" class="txta"></td>
  </tr>
  <tr>
    <td colspan="2"><label>Company:</label></td>
  </tr>
  <tr>
    <td colspan="2"><input type="text" name="field_company" value="" class="txta"></td>
  </tr>
  <tr>
    <td colspan="2"><label>Phone:</label></td>
  </tr>
  <tr>
    <td colspan="2"><input type="text" name="field_telephone" value="" class="txta"></td>
  </tr>
  <tr>
    <td colspan="2"><label>Address:</label></td>
  </tr>
  <tr>
    <td colspan="2"><input type="text" name="field_address" value="" class="txta"></td>
  </tr>
  <tr>
    <td><label>State:</label></td>
    <td><label>Zip:</label></td>
  </tr>
  <tr>
    <td><input type="text" name="field_state" value="" class="txtb"></td>
    <td><input type="text" name="field_postcode" value="" class="txtb"></td>
  </tr>
  <tr>
    <td colspan="2">&nbsp;</td>
  </tr>
  <tr>
    <td><input type="image" src="{$CONTEXT.STYLEIMG}btn_submit.jpg" onclick="hbfm_submit();return false;" /></td>
    <td><input type="image" src="{$CONTEXT.STYLEIMG}btn_clear.jpg" onclick="hbfm_reset();return false;" /></td>
  </tr>
  <tr>
    <td colspan="2">Your information is safe with us!</td>
  </tr>
</table>
</form>
</div>
</div>

</div>
</div>

{literal}
<style type="text/css">
div.hbfmd {
	padding: 10px 35px 10px 10px;
	color: #b28750;
}
div.hbfmd table {

}
div.hbfmd label {
	color: #022d72;
	font-family: Verdana, Geneva, sans-serif;
	font-size: 11px;
}
div.hbfmd input.txta {
	width: 240px;
	height: 16px;
	margin-bottom: 3px;
}
div.hbfmd input.txtb {
	width: 100px;
	height: 18px;
}
</style>
<script type="text/javascript" language="javascript">
function hbfm_submit(){
	var form = document.contactusform;
	if( form.field_name.value == "" ) {
		form.field_name.focus();
		return false;
	}
	if( form.field_email.value == "" ) {
		form.field_email.focus();
		return false;
	} else if( checkEmail(form.field_email.value) == false ) {
		form.field_email.select();
		form.field_email.focus();
		return false;
	}
	if( form.field_telephone.value == "" ) {
		form.field_telephone.focus();
		return false;
	}
	if( form.field_address.value == "" ) {
		form.field_address.focus();
		return false;
	}
	if( form.field_state.value == "" ) {
		form.field_state.focus();
		return false;
	}
	
	xc('ws_contactus', [xcgfm('contactusform')]);
}
function ws_contactus_cb(r) {
	if( r == 1 ) {
		alert("Thank you for your contact with us.\nWe will contact you for arranging your free estimate.");
		var form = document.contactusform;
		form.reset();
		form.field_name.focus();
	} else {
		alert("ERROR");
	}
}
function hbfm_reset(){
	var form = document.contactusform;
	form.reset();
	form.field_name.focus();
}
</script>
{/literal}